This study explores the etiological context of family relations in obsessive-compulsive disorder, along with the incidence of obsessive-compulsive disorder among relatives. Family data have been collected on 174 relatives of ten severely obsessive-compulsive patients. These rather isolated families had cultures which emphasized cleanliness and perfection, but other family members did not develop rituals or obsessive rationales as the patient did. Typically one or both parents in an unfulfilled marriage directed symbiotic needs toward the patient. Parents and offspring became trapped in an increasingly powerless struggle against symptoms which acted as a barrier to closeness, but also prevented the patient from developing an autonomous existence.